FOOTHILL COLLEGE

Supine Patient Spinal Immobilization

Candidate Name: _________________________________________ Date: ______________________

Examiner Name and Signature: _________________________________________________________

Time Started: __________ Time Ended: __________ Points: _____/13 PASS/FAIL (Circle One)

Points Possible Points Awarded
Directs assistant to place/maintain head in the neutral, in-line position 1
Directs assistant to maintain manual immobilization of the head 1
Assesses motor, sensory, and circulatory functions in each extremity 1
Applies appropriately sized extrication collar 1
Positions the immobilization device appropriately 1
Directs movement of the patient onto the device without compromising the integrity of the spine 1
Applies padding to voids between the torso and the device as necessary 1
Immobilizes the patient’s torso to the device 1
Evaluates and pads behind the patient’s head as necessary 1
Immobilizes the patient’s head to the device 1
Secures the patient’s legs to the device 1
Secures the patient’s arms to the device 1
Reassesses motor, sensory, and circulatory function in each extremity 1

                                          Total Points Awarded_______________

Critical Criteria

●      Did not immediately direct or take manual immobilization of the head

●      Failure to maintain stabilization of the patient’s head in a neutral, in-line position

●      Did not properly apply appropriately sized cervical collar

●      Released or order release of manual immobilization before it was maintained mechanically

●      Manipulated or moved patient excessively causing potential spinal compromise

●      Head immobilized to device before torso sufficiently secured to device

●      Head immobilization allows for excessive movement

●      Device moves excessively on the patient’s torso

●      Torso fixation inhibits chest rise, resulting in respiratory compromise

●      Upon completion of immobilization, head is not in a neutral, in line position

●      Did not reassess motor, sensory, and circulatory functions in each extremity after securing patient to backboard

Notes: ____________________________________________________________________________________________

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